2009 Annual Report About the Cover Design elements of the Cancer Annual Report are based on the famous double helix model of the DNA molecule discovered by Watson and Crick in the mid-twentieth century combined with the universal ribbon symbol of awareness. Fact American women have the highest incidence rates of breast cancer in the world.

December 30, 2009

We are pleased to present the 2009 Cancer Annual Report. This year’s report includes a review of 2,953 breast cancer cases diagnosed at Woman’s Hospital between 1998-2008. You will note that 30% of breast cancer cases were diagnosed in women less than 50 years old compared to 22% diagnosed in this age group nationally. This will be important for us to consider when reviewing and evaluating recommended changes for .

In addition to reporting our cancer statistics, we have focused on the evolving understanding of the role that genetics plays in the development of cancer. Since the 1953 discovery of DNA structure by Watson and Crick and particularly with the completion of the human genome project in 2000, we have begun to understand the genetic language of cancer. Recent breakthroughs are allowing researchers to identify patients at increased risk for the development of cancer, to identify cancer earlier, and to design treatments that target the genetic errors in cancer cells. We hope, with this increasing knowledge, we will no longer view cancer as simply a life threatening disease, but as a group of disorders—often genetic in origin—amenable to new and more effective therapies.

Sincerely, David Boudreaux, MD Beverly Ogden, MD Cancer Liaison Physician Chairman Cancer Committee

1953 Drs. James Watson and Francis Crick’s discovery of the double helix structure of DNA is the historical milestone that leads to the development of the field of molecular biology. 1

The Inheritance of Cancer Questions about family history have Guidelines used to determine an CancerAll have genetic basis, which long been a standard part of any history inherited predisposition to cancer means it takes a change (mutation) in a and physical. While only 10% of cancers include: cell’s genes/DNA to turn a normal cell have been proven to have a genetic • Family history of two or more family into a cancer cell. Cancer is not a one- component, many cases of inherited members (on the same side of the step process. Most human tumors result breast and ovarian cancer are linked family) with cancer; to BRCA1 and BRCA2 gene mutations. Discussionfrom a complex sequence of mutational • Families of Ashkenazic Jewish descent; events, each of which contributes to the BRCA1 mutations are associated with breakdown of regulatory mechanisms that the risk of development of breast cancer, • Family history of early age onset cancer; govern normal cell behavior. Although all ovarian cancer, colon cancer, cervical • Family history of bilateral breast cancer; cancers are genetic, only approximately cancer, uterine cancer, pancreatic cancer 10% of cancers are believed to be and in families. BRCA2 • Family history of more than one type of inherited. Inherited cancer occurs when mutations are associated with the risk of cancer; and, a patient is born with a genetic mistake development of breast cancer, ovarian • Family history of . that predisposes that person to develop cancer, male breast cancer, melanoma, cancer. As an inherited disorder, cancer is pancreatic, stomach, gallbladder and bile Guidelines for the management of a an autosomal dominant disease process. duct cancer. family with an inherited risk for cancer: If a patient inherits a gene for cancer, Prior to testing for such mutations, genetic A woman with an inherited risk of that individual has approximately an 85% counseling is essential, because the test breast cancer may choose prophylactic chance of developing cancer by the age results may affect not only the patient’s /oophorectomy or of 65 and a 50% chance of passing this life but the lives of an entire family for surveillance. A non-surgical management genetic predisposition on to offspring. generations. After decades of aggressive pathway includes six-month imaging educational campaigns by cancer societies, of MRI alternating with mammography the message about the importance of beginning at age 25, transvaginal family history and early detection has been ultrasound of the ovaries for early heard–and heeded. detection of ovarian lesions and also evaluation of CA 125 serum levels starting These days, requests for genetic testing at age 25. Beginning between the ages from concerned patients increase every of 20-30, colonoscopy screenings should year. However, genetic testing isn’t be performed every one-two years and, appropriate for all families. While testing subsequently, every year after age 40. for cancer genes has been available since Endometrial biopsies should be performed the mid-1990s, only recently have medical yearly beginning at age 35. Male family professionals pinpointed who should be members should have increased and early tested by reviewing the patient and family PSA screenings and prostate exams. histories.

For nearly 15 years, Duane W. Superneau, MD, has counseled Woman’s patients about whether such tests are truly warranted, interpreted screening results and helped those who have been found to have genetic cancer predisposition to understand their risks and manage their health.

1962 Dr. Henry Lynch, a medical resident at the University of Nebraska Medical Center, describes a syndrome 2 that affects a family in which most members died of inherited colon or gynecologic cancer. Fact Breast cancer is about 100 times as frequent among women as among men, but survival rates are equal in both sexes.

MRI and Breast Cancer can often mimic a recurrent cancer, and Breast MRI is a very sensitive test, and While mammography and breast MRI can often help distinguish between on occasion normal tissue will mimic a ultrasound remain the main diagnostic the two. Since 2006, over 1,600 breast MRIs mass and require biopsy. Roughly 15% imaging tools for evaluation of breast have been performed at Woman’s. of high-risk screening patients will have an abnormal MRI requiring biopsy, and disease, Magnetic Resonance Imaging One of the limitations of mammography is two-thirds of these will be benign. This (MRI) has become a valuable third imaging the ability to demonstrate a cancer if the false positive result is one limitation of modality for select patients. Woman’s patient has dense underlying breast tissue. MRI. For this reason, MRI screening is not Hospital purchased an MRI scanner in This is a very common situation in younger recommended for the general population. early 2006, and has been a pioneer in the premenopausal women, and even in some community for evaluation of breast cancer postmenopausal patients. MRI imaging Occasionally, a breast mass will be evident and MRI-guided breast core biopsies. is not affected by breast tissue density. only on the MRI scan. In these patients, an MRI of the breast is most commonly For this reason, MRI has become an ideal MRI-guided biopsy is necessary. Woman’s performed after the diagnosis of breast modality to screen patients at high risk for Imaging Department has one of the few cancer. In approximately 20% of these breast cancer. This includes women who MRI-compatible breast biopsy devices patients, MRI will demonstrate more have tested positive for a breast cancer in the region. The addition of MRI to our extensive spread of the cancer in the gene, a very strong family history of breast hospital has brought us to the forefront in affected breast, and helps the surgeon cancer, or history of the battle of breast cancer diagnosis. plan accordingly. Also, in 5% of these to the chest at a young age. Cancers cancer patients, MRI can detect an diagnosed in high-risk patients by MRI unknown cancer in the opposite breast. are typically Stage 0 or 1 as compared After surgery for breast cancer, scar tissue to Stage 1 or 2 disease diagnosed by mammography.

Woman’s 2009 Cancer Annual Report 3 Fact There are different types of breast cancer, with different stages, aggressiveness and genetic makeup.

The 2009 Cancer Annual Report reflects a review of all breast Breastcancer cases diagnosed at Woman’s Hospital from 1998-2008. In Breast 1998, 194 cases of breast cancer were diagnosed compared to 373 cases diagnosed in 2008 representing an almost two-fold increase. Approximately 30% of cases were diagnosed in women less than 50 years old compared to 22% diagnosed in this age group nationally. Also, 18% of cases were diagnosed at Stage 0, carcinoma Cancerin-situ, compared to 19% found in the National Cancer Data Base. Cancer were performed in 47% of Stage 0 cases, 42% of Stage I cases, 54% of Stage II cases, 84% of Stage III cases, and 48% of Stage IV cases.

As expected, 5-year survival data demonstrate better survival in OverviewStage 0, I and II disease with 80%-89% survival in African-American Data women and 84%-95% survival in Caucasian women. A dramatic drop in survival is noted with Stage III disease, 57% for both African- American and Caucasian women. As expected the worst survival is seen with Stage IV disease, with 12% survival among African- American women and 29% survival among Caucasian women. Stage for stage there is a racial disparity in survival rates, except for Stage III disease. This has been a consistent finding in our annual Analysis reports and may reflect underlying intrinsic differences in the overall health of African-American women or other predisposing factors when compared to Caucasian women.

4 Woman’s 2009 Cancer Annual Report The following tables and graphs represent Woman’s Hospital data for Breast Cancer cases for the years 1998-2008 with available comparative Breastnational and regional data.

Table I Woman’s Hospital NCDB** Breast Cases Age at Diagnosis Number Percent Number Percent Age at Diagnosis: Pediatric N/A 39 <1 Years 1998-2008 Cancer16-29 18 1 4,792 <1 30-39 188 6 54,006 4 40-49 688 23 224,320 18 50-59 810 27 309,651 25 60-69 613 21 269,668 22 70-79 471 16 227,184 19 80-89 147 5 118,555 10 Data90-99 18 1 11,532 1 Total 2,953 100 1,219,747 100

**NCDB data only available for years 2000-2006.

Our local data fairly closely parallel those of the National Cancer Data Base (NCDB), with Analysispeak incidence in the sixth decade and only rare cases diagnosed in the first three decades of life. The steep drop in incidence after the eighth decade most likely reflects the accelerated mortality from all causes in these elderly patients.

Table II Woman’s Hospital NCDB** Breast Cases Race Number Percent Number Percent Racial Incidence: Years 1998-2008 Caucasian 2,215 75 991,159 81 African American 717 24 117,472 10 Asian 15 <1 31,120 2 Other* 6 <1 79,996 7 Total 2,953 100 1,219,747 100

*Other category includes Native American and Hispanic.

**NCDB data only available for years 2000-2006.

Some variation from NCDB data is noted in Woman’s data for racial spread, but this most likely reflects a difference in the regional population mix compared with the national population as a whole.

1980 The American Society of Human Genetics is a counsel of the American Board of Medical Genetics to certify medical geneticists and genetic counselors and to accredit training programs. 5 Fact With best treatment, 10-year disease-free survival varies from 98% to 100%.

Table III Woman’s Hospital Breast Cases Year of Diagnosis * Number of Breast Cancer Cases Percent Year of Diagnosis: Years 1998-2008 1998 194 <7 1999 253 9 2000 212 7 2001 182 6 2002 223 7 2003 255 9 2004 303 10 2005 258 9 2006 321 11 2007 379 13 2008 373 13 Total 2,953 100

* Year of diagnosis is based on accession year.

A slight apparent increase in the annual number of breast cases diagnosed over the past 11 years may reflect increasing awareness of breast cancer and its earlier diagnosis.

Table IV Invasive Neoplasms Breast Cases Woman’s Hospital NCDB* Histology: Cell Type Number Percent Number Percent Years 1998-2008 Infiltrating Ductal Carcinoma 2,080 87 815,294 67 Lobular Carcinoma 178 7 108,958 9 Infiltrating Ductal and Lobular Carcinoma 119 5 74,243 6 Other 22 1 221,252 18 Total 2,399 100 1,219,747 100

Non-Invasive Neoplasms** Woman’s Hospital NCDB* Cell Type Number Percent Number Percent Ductal Carcinoma In-Situ 430 78 N/A N/A Lobular Carcinoma In-Situ 14 2 N/A N/A Mixed Ductal Carcinoma In-Situ and Lobular Carcinoma In-Situ 109 20 N/A N/A Borderline 1 <1 N/A N/A Total 554 100 N/A N/A

** Non-invasive neoplasms were not available for comparison in NCDB data. * NCDB data only available for years 2000-2006.

These data demonstrate that invasive ductal carcinomas greatly outnumber other forms of invasive cancer. This is also true of ductal carcinoma in-situ relative to other forms of in-situ cancer. Comparative NCDB data are only available for invasive tumors, and examination of these data suggest that a cancer is more likely to be classified by type at Woman’s than is the case nationally.

6 Woman’s 2009 Cancer Annual Report Table V Woman’s Hospital NCDB* Breast Cases Stage at Diagnosis Number Percent Number Percent Stage at Diagnosis: 0 531 18 224,339 19 Years 1998-2008 I 1,103 37 463,180 38 II 937 32 334,077 27 IIA 651 22 IIB 286 10 III 248 9 98,357 8 IIIA 156 6 IIIB 64 2 IIIC 28 1 IV 39 1 40,277 3 N/A/Unknown** 95 3 59,517 5 Total 2,953 100 1,219,747 100

*NCDB data only available for years 2000-2006. ** There are 23 cases of non-invasive neoplasms that are included in N/A /Unknown category on Table V.

Comparison of our local staging of breast tumors very closely parallels national percentages for all major stage groups.

Table VI • Breast Cases • First Course of Treatment: Years 2000-2006

Woman’s Hospital Stage Treatment First Course Lumpectomies Mastectomies Number Percent 0 1721 151 323 100 Surgery 20 108 128 40 Surgery/Chemotherapy 0 3 3 1 Surgery/Radiation 97 12 109 34 Surgery/Chemotherapy/Radiation 3 1 4 1 Surgery/Hormone 10 24 34 10 Surgery/Radiation/Hormone 42 1 43 13 Surgery/Radiation/Chemotherapy/Hormone 0 2 2 1

I 3722 272 644 100 Surgery 19 124 143 22 Surgery/Chemotherapy 5 29 34 5 Surgery/Radiation 135 13 148 23 Surgery/Chemotherapy/Radiation 62 17 79 12 Surgery/Hormone 3 58 61 10 Surgery/Chemotherapy/Hormone 0 18 18 3 Surgery/Radiation/Hormone 107 3 110 17 Surgery/Radiation/Chemotherapy/Hormone 41 10 51 8

1 For Stage 0 Lumpectomies surgery only patients, five patients refused radiation treatment, eight patients did not receive radiation treatment due to health complications and seven patients did not receive radiation treatment for reasons not otherwise specified.

2 For Stage I Lumpectomies surgery only patients, three patients refused radiation treatment, four patients did not receive radiation treatment due to health complications and twelve patients did not receive radiation treatment for reasons not otherwise specified.

1985 HER2/neu, a tumor oncogene, is cloned and found to be frequently amplified in human breast cancer. 7 Woman’s Hospital Stage Treatment First Course Lumpectomies Mastectomies Number Percent II 2623 311 573 100 Surgery 12 88 100 17 Surgery/Chemotherapy 6 57 63 11 Surgery/Radiation 36 15 51 9 Surgery/Chemotherapy/Radiation 118 43 161 28 Surgery/Hormone 0 29 29 5 Surgery/Chemotherapy/Hormone 0 37 37 6 Surgery/Radiation/Hormone 23 4 27 5 Surgery/Radiation/Chemotherapy/Hormone 66 38 104 18 Radiation/Chemotherapy 1 0 1 1

III 264 133 159 100 Surgery 4 19 23 14 Surgery/Chemotherapy 0 14 14 9 Surgery/Radiation 2 12 14 9 Surgery/Chemotherapy/Radiation 12 52 64 40 Surgery/Hormone 0 3 3 2 Surgery/Chemotherapy/Hormone 0 1 1 1 Surgery/Radiation/Hormone 2 3 5 3 Surgery/Radiation/Chemotherapy/Hormone 5 29 34 21 Chemotherapy 1 0 1 1

3 For Stage II Lumpectomies surgery only patients, six patients refused radiation treatment and six patients did not receive radiation treatment for reasons not otherwise specified.

4 For Stage III Lumpectomies surgery only patients, three patients did not receive radiation treatment due to health complications and one patient did not receive radiation treatment for reasons not otherwise specified.

1986 The first tumor suppressor gene (retinoblastoma gene) is found to be associated with an inherited form of cancer 8 of the eye in children, proving defective inherited genes may lead to the development of cancer. Fact Some breast cancers may require the hormones estrogen and progesterone to grow, and have receptors for those hormones.

Woman’s Hospital Stage Treatment First Course Lumpectomies Mastectomies Number Percent IV 145 13 27 100 Surgery 3 2 5 19 Surgery/Chemotherapy 1 4 5 19 Surgery/Chemotherapy/Radiation 2 5 7 26 Surgery/Chemotherapy/Hormone 0 1 1 <4 Surgery/Radiation/Hormone 1 0 1 <4 Surgery/Radiation/Chemotherapy/Hormone 0 1 1 <4 Hormone 1 0 1 <4 Chemotherapy 3 0 3 11 Radiation/Chemotherapy 1 0 1 <4 None 2 0 2 7

N/A Unknown 146 14 28 100 Surgery 4 6 10 36 Surgery/Chemotherapy 2 1 3 11 Surgery/Radiation 3 4 7 25 Surgery/Chemotherapy/Radiation 0 1 1 <4 Surgery/Hormone 1 0 1 <4 Surgery/Chemotherapy/Hormone 0 1 1 <4 Surgery/Radiation/Hormone 3 1 4 14 Chemotherapy 1 0 1 <4

5 For Stage IV Lumpectomies surgery only patients, three patients did not receive radiation treatment for reasons not otherwise specified.

6 For N/A or Unknown stage Lumpectomies surgery only patients, four patients did not receive radiation treatment for reasons not otherwise specified.

These data display first course of treatment modalities for all stages of breast cancer at Woman’s, also segregating patients who have had lumpectomies versus mastectomies for comparison.

Woman’s 2009 Cancer Annual Report 9 Fact Low-risk, hormone-sensitive breast cancers may be treated with hormone therapy and radiation alone.

Table VII • Breast Cases • NCDB Comparison • First Course of Treatment: Years 2000-2006 Woman’s Hospital NCDB* Treatment Lumpectomies Mastectomies All Cases Percent Cases Percent Surgery 62 347 409 23 318,196 26 Surgery/Radiation 273 56 329 19 144,230 12 Surgery/Chemotherapy 14 108 122 7 105,557 9 Surgery/Radiation/Chemotherapy 197 119 316 18 116,003 9 Surgery/Radiation/Hormone 178 12 190 11 165,235 14 Surgery/Hormone 14 114 128 7 86,003 7 Surgery/Radiation/Chemotherapy/Hormone 112 80 192 11 84,765 7 Surgery/Chemotherapy/Hormone 0 58 58 3 38,343 3 Other Specified Therapy 8 0 8 >1 110,207 9 None 2 0 2 >1 51,208 4 TOTAL 860 894 1,754 100 1,219,747 100

* NCDB data only available for years 2000-2006.

This table permits comparison of our first course of treatment modalities with national data. This required all stages be grouped together by treatment modality, and our local percentages roughly parallel national percentages. Differences, however, do exist. Locally, breast cancer patients are somewhat less likely to have surgery only and more likely to undergo surgery with radiation therapy and/or chemotherapy than reported nationally.

Table VIII Breast Cancer: 5-Year Survival by Stage (Woman's Hospital Cases Only) 99% 98% 97% 100% 98% 98% 96% 93% 94% 95% 96% 94% 93% 90% 88% 84% 83% 80% 75% 75% 69% 59% 60% 50% Stage 0 (531) Stage I (1,103) 40% Stage II (937) 26% 21% Stage III (248) 20% 1 year 2 years 4 years 5 years Stage IV (39) 3 years As might be expected, 5-year survival data for Woman’s cases demonstrate the best rates of survival for Stage O and Stage I patients, which are nearly identical. Data for Stage II, III and IV patients exhibit progressively worse survival rates.

10 Woman’s 2009 Cancer Annual Report Table IX Breast Cancer: 5-Year Survival by Stage (Compared with National and Regional Data) 100% 98% 95% 97% 92% 97% 93% 89% 93% 90% 90% 87% 86% 87% 84% 80% 83%

WH Overall 60% NCDB Southeast* * Southeast: 40% DE, FL, GA, MD, NC, SC, VA, DC, WV 1 year 2 years 3 years 4 years 5 years

Comparison of 5-year survival for all Woman’s cases, combining all stages, with both regional (Southeastern US) and national (NCDB) data, demonstrates nearly identical survival rates among these three groups.

Table X Breast Cancer: 5-Year Survival by Stage - Comparison of Woman's Hospital (WH) and National (NCDB) Data Stage 0 100% 99% 99% 98% 98% 99% 98% 96% 97% 96% 95% 96% 94% 93% 92%

Stage 0 WH (531) 90% Stage 0 NCDB (96,867) 1 year 2 years 3 years 4 years 5 years

99% Stage I 100% 98% 99% 96% 97% 94% 95% 95% 93% 93% 91% 90%

85%

Stage I WH (1,103) 80% 1 year 2 years 3 years 4 years 5 years Stage I NCDB (22,2437)

1989 Michael Bishop and Harold Varmus are awarded the Nobel Prize in Medicine for a 1976 discovery that viruses contain a cancer-causing gene (oncogene) derived from the genes of the organisms they infect. 11 Fact According to the Merck Manual, more than 80% of breast cancer cases initially come to medical attention when a woman feels a lump.

Stage II 98% 100% 95% 98% 90% 94% 88% 90% 90% 83% 86% 80% 82%

70%

Stage II WH (937) 60% 1 year 2 years 3 years 4 years 5 years Stage II NCDB (178,514)

Stage III 100% 94% 92% 84% 80% 75% 80% 69% 71% 59% 60% 63% 56%

40%

Stage III WH (248) 20% 1 year 2 years 3 years 4 years 5 years Stage III NCDB (36,855)

Stage IV 100% 75% 80%

62% 50% 60% 44% 32% 24% 19% 26% 40% 21%

Stage IV WH (39) 20% 1 year 2 years 3 years 4 years 5 years Stage IV NCDB (19,914) Comparison of 5-year survival by stage of all Woman’s cases with national (NCDB) data also demonstrate closely parallel rates of survival for each stage.

12 Woman’s 2009 Cancer Annual Report Table XI Breast Cancer: 5-Year Survival by Race [Comparison with National (NCDB) Data] 98% 100% 98% 97% 96% 97% 95% 93% 93% 92% 90% 90% 91% 90% 89% 88% 87% 86% 86% 84% 83% 80% 80% African American (717) Caucasian (2,215) Overall (2,953) 70% 1 year 2 years 3 years 4 years 5 years NCDB

Comparison of 5-year survival by race at Woman’s with national (NCDB) data demonstrates that our Caucasian population have uniformly better survival rates than seen nationally, but also substantially better survival rates than the Woman’s African-American population. The reasons for these racial differences have not been determined, but data do not suggest delay in diagnosis as a cause.

This racial difference among Woman’s patients was also noted to varying degrees in each stage group. Also, essentially no difference in survival based solely on age was noted.

1990 Dr. Mary-Claire King discovers a single gene on chromosome 17 (BRCA1) is responsible for many cases of inherited breast and ovarian cancer. Under the leadership of Dr. James Watson, the Human Genome project begins; its goal is to identify the genetic makeup of the human species. 13 Continuing Medical Education Gynecologic Oncology Services protocols and registers patients in Woman’s Hospital is accredited by Woman’s provides inpatient and outpatient clinical trials, giving women access to the the Louisiana State Medical Society to diagnostic services, surgery, chemotherapy latest treatments. All of our gynecologic Woman’sprovide continuing medical education for administration, symptom management oncology patients have access to physicians. The mission of the hospital’s and supportive care for women with a presentations at the multidisciplinary continuing medical education program diagnosis of gynecologic cancer. Woman- Gynecologic Tumor Conference, genetic is to offer appropriate programs related to-Woman, a monthly , counseling and participation in national to the healthcare of women, children and provides educational seminars and a trials. infants. means of sharing information about The oncology data manager, a registered Supportlocal resources, local support groups As part of continuing medical education, nurse at Woman’s, works with the and reliable websites. Two educational Mark Newman, MD, presented Adnexal gynecologic oncologists at Woman’s and programs are held each year for cancer Masses in Pregnancy on Tuesday, July 1, with GOG to provide the best possible survivors and their families: Celebrate 2008, at Woman’s Hospital. treatment for patients. The oncology data Life in the spring and Women Living with manager registers patients on GOG clinical ServicesFood and Nutrition Services Cancer in the fall. trials to assure the staff adheres to the Registered dietitians ensure patients criteria involved in the research protocol. A receive adequate nutrition. The nurse phones each gynecologic oncology education of patients involves stressing Gynecologic Oncology Group patient (even those not participating in a the importance of eating properly and (GOG) research protocol) within seven to 10 days developing a nutritional care plan. The Woman’s is one of four institutions after chemotherapy administration. The plan provides patients with coping in Louisiana that participates in the nurse reviews potential side effects, offers strategies to deal with the possible side Gynecologic Oncology Group (GOG). emotional support, answers questions effects of their treatments. The GOG is a national collaborative approved by the physicians, continues group funded by the federal government Room service is a concept most women education program initiated during the through the National Cancer Institute equate with a high-end hotel, not a initial chemotherapy visit and may refer the (NCI). GOG is the only group that focuses hospital. However, in 2004, Woman’s patient with complex issues to a physician, its research on women with pelvic initiated a pilot room service plan on the social worker or dietitian. The purpose of malignancies, such as cancer of the ovary, oncology unit. The innovative program this follow-up is to minimize side effects, uterus and cervix. allows patients to order meals when continue teaching and reinforce the they are hungry rather than delivering A group of leading oncologists founded hospital’s commitment to the patient’s trays at pre-determined times. By 2005, the GOG in 1970. They believed a nation- well-being. this program—the first of its kind in area wide cooperative effort by a variety of In 2008, the oncology data manager made hospitals—was expanded to include all specialists would allow for a more rapid 558 calls to patients. Subsequently, 74 units. While patient satisfaction with the accumulation of information concerning patients were referred to their physician, quality of food served at Woman’s has treatment for gynecologic cancer. The GOG and four were referred to social services. always been high, this pilot program designs and implements clinical trials in Below is a summary of participation in brought the food service satisfaction all aspects of gynecologic cancer. These GOG studies for 2008: rating to 99%. research studies compare the best existing treatments with promising new ones. GOG • 1 patient was registered on GOG continues to pave the way in gynecologic treatment protocol; oncology trials, setting the standard for • 181 patients were reviewed for GOG cancer research and treatment. protocols; • 163 patients were ineligible for GOG The GOG program at Woman’s was treatment protocols; initiated in 1988. Gynecologic Oncologist • 23 patients were registered on GOG Giles Fort, MD, directs the gynecologic non-treatment protocols; oncology research program at Woman’s, • 10 GOG protocols were approved by the which is affiliated with the GOG through Institutional Review Board; Wake Forest University School of Medicine • 31 patients are being actively followed in Winston-Salem, N.C. Through this on GOG studies. affiliation, Woman’s participates in GOG

14 Woman’s 2009 Cancer Annual Report Fact According to the American Cancer Society, the first medical sign—or objective indication of breast cancer as detected by a physician—is discovered by mammogram.

Imaging Services Pathology/Laboratory Pharmacy The imaging services department Pathology/Laboratory offers anatomic The pharmacy department follows the offers general diagnostic radiology pathology, bacteriology/serology/virology, mission of the American Society of Health- and fluoroscopy imaging, ultrasound blood transfusions, clinical chemistry, System Pharmacists by helping to ensure examinations, nuclear medicine, cytogenetics, cytology, hematology/ the best use of medications. Pharmacy Computed Tomography (CT), coagulation/urinalysis and special services include dispensing oral and and Magnetic Resonance Imaging (MRI) chemistry. These services include testing intravenous medications, chemotherapy for both inpatients and outpatients. that is related to cancer diagnoses and and drugs used in clinical trials. The monitoring, such as CA-125, AFP, B-HCG, pharmacy also provides drug information A staff of board-certified radiologists, and Her2/neu FISH and Urovysion FISH. services. registered nurses, technologists and The laboratory is under the direction support staff provide a supportive For patient safety, one pharmacist reviews of board-certified pathologists and is atmosphere for patients in all imaging each chemotherapy order for accuracy inspected and accredited by the College of services. by comparing it with current dosing American Pathologists. recommendations in medical literature or Our breast imaging services staff provides the protocol’s dosing regimen for research screening and diagnostic mammography, Cancer Detection Laboratory The concept of Pap smears as a means study patients. A second pharmacist needle localization, galactography, and of detecting precancerous lesions was checks the drug order information entered cyst aspiration, as well as stereotatic, in its infancy when Cary Dougherty, MD, in the patient’s medication profile and ultrasound-guided and MRI-guided breast founded the Cancer Detection Laboratory verifies the correct drug and dose have core biopsy. All mammography studies are (CDL) in 1958. In the 50 years since, more been selected prior to preparation. read by two board-certified radiologists than 1 million Pap smears have been and Computer-Assisted Detection (CAD) processed at Woman’s, and the CDL Respiratory Care as well, providing triple review for all Respiratory care provides diagnostic and has received recognition for its quality mammography studies. therapeutic services to both inpatients and assurance practices, which exceed all outpatients. Respiratory care practitioners Woman’s also provides digital screening regulation standards. collaborate with physicians and nurses mammography services using a state-of- The CDL is one of the nation’s oldest to maintain physiological homeostasis the-art mobile mammography coach. Our cytology laboratories. During the first two of the patient. Under the direction of a mobile program, which provided screening years of its operations, 4,732 Pap smears physician, therapists evaluate, treat and mammography for 5,800 patients last year were processed. Today, more than 90,000 care for patients with breathing disorders. in 15 surrounding parishes, is built on a cases per year are processed. The fees Respiratory care practitioners are a vital collaborative partnership which enables charged during the early days of the CDL part of the hospital’s lifesaving response us to provide breast care to low-income, were used to pay the $64,000 purchase team with current Louisiana RCP licensure, at-risk, uninsured and underinsured price for the land on which Woman’s BCLS, PALS, NRP and ACLS certifications. women in outlying areas. Our collaborative Hospital was built. partners include Mary Bird Perkins CARE Social Services Network, YWCA, Encore plus, LSU Health Directed by a pathologist board certified Social workers provide emotional support Care System, Louisiana Breast and Cervical in cytopathology and staffed by certified for patients and their families. They discuss Health Program and Susan G. Komen experienced cytotechnologists, CDL the patient’s feelings toward her diagnosis Foundation. The mobile program identified performs cytological and histological and integrate this information into the 25 cancers last year among women whose correlations on abnormal Pap smears treatment plan. The department also helps cancers may not have otherwise been and participates in nationally recognized coordinate any services the patient needs detected. proficiency surveys. The lab adheres during recovery and links the patient and to the workload standards set by the her family with the hospital’s support American Society of Cytology. The lab has groups and community services. also passed inspection by and met the accreditation requirements of the College of American Pathologists.

1993 Four scientific teams discover the inherited cancer genes called HNPCC (Hereditary Non-Polyposis Colon Cancer), which are associated with Lynch Syndrome. These inherited mutations appear in 2% to 3% of all colon cancers. 15 Surgical Services Woman’s also offers a comprehensive Woman’s Center for Wellness The staff of surgical services specializes management program, Our center can be considered a place of in oncologic, reconstructive plastic, including exercise, education, manual refuge offering wellness services for the breast, general, gynecologic and lymphatic techniques, compression entire spectrum of health. The Fitness urogynecologic surgery and minimally bandaging and use of a gradient Club staff develops an individualized invasive endoscopic surgical procedures. sequential pump. The lymphedema program to meet each member’s unique In November 2007, Woman’s added the management program educates patients health needs. The club creates classes and daVinci® robotic system to its surgical about prevention and treatment options. programs for the mind, body and spirit. repertoire. Robotic surgery is a minimally Outpatient services are available for Many educational offerings are available invasive technique that reduces recovery patients who need ongoing rehabilitation to members and the general public. These time associated with hysterectomies and after breast or abdominal surgery or for programs are focused on restoration of other gynecological surgeries. generalized weakness after prolonged better health through stress reduction, nutrition, strength and flexibility and The day surgery staff preoperatively illness. The Forward Motion program was improved balance. Nutrition plays an cares for ambulatory surgery patients established in 2003 to help these women integral role in healing, disease prevention and inpatients in private rooms. After successfully transition from therapy to and treatment. Women throughout the surgery, ambulatory surgery patients independent exercise and bridges the city are invited to participate in a variety recover in their preoperative room, and gap for patients who are discharged from of nutrition offerings—consultations, inpatients are admitted to a private room physical therapy and need support to cooking classes, grocery tours and support on a nursing unit. In addition, critical care maintain a therapy program. Therapists groups. Located within Woman’s Center professionals staff the adult intensive care guide Forward Motion patients through for Wellness, our spa offers soothing unit (AICU) 24 hours a day/7days a week. individualized exercise programs treatments, including massages and To ensure post-surgical patients receive that incorporate different wellness facials. All of these services and programs adequate pain control, board-certified components, such as flexibility, strength, aid in health maintenance as well as anesthesiologists remain in the hospital 24 endurance, body composition and healing. hours a day to provide pain management cardiovascular and stress management. and anesthesia care. In 2006, elements of the Forward Motion program were incorporated into a program to help cancer patients maintain Therapy Services their strength. The Cancer Health and Therapy services at Woman’s Center Fitness program is designed for patients for Wellness offer patients a broad who are receiving treatment as well as for spectrum of treatments. Patients who those who want to start exercising but are on extended bed rest may require who need guidance in determining a safe physical and occupational therapies to level of physical exertion. This program become as independent as possible in combines therapy, Forward Motion daily activities. Physical or occupational techniques and independent exercise to therapists evaluate each patient’s level of help improve overall fitness by increasing physical activity and prescribe exercises to strength and endurance, reducing pain maintain or increase functional ability. and improving function.

1994 Woman’s opens the Woman’s Health Research Institute and Molecular Biology Laboratory with funding of $250,000 raised by the Baton Rouge community and starts a collaborative study with 16 Dr. Mary-Claire King to investigate inherited breast cancer in Louisiana. Fact A woman’s risk of breast cancer is higher if her mother, sister or daughter has had breast cancer.

Development Philanthropic giving allows individuals, corporations and private foundations to invest in organizations like Woman’s and other non-profits that meet critical community needs. The office of development remains committed to helping donors make a difference. Its mission is “to raise funds to support the mission of the Hospital by building long-term relationships between the Hospital and the community through communication, education, and stewardship.”

Woman’s is focused on building a comprehensive development program consisting of an annual giving program, a major gifts program, a capital campaign, and a planned giving program. The following events were part of our 2008 annual giving program:

T enth Annual Woman’s Victory Open Ninth Annual Tour of Ponds Second Annual Rock-N-CHAIRity The Woman’s Victory Open is an exciting The Ninth Annual Tour of Ponds, held Rock-N-CHAIRity is a unique fundraising all-women’s golf tournament that supports on May 31 and June 1, 2008, showcased event hosted by Woman’s Circle of breast cancer outreach and education. more than 25 private water gardens in Friends. It includes great food, fun and Woman’s Victory Open is the premier the Greater Baton Rouge area. Since its an auction featuring one-of-a-kind chairs women’s charity golf event in Louisiana. inception in 1999, the Tour of Ponds has created by artists from the community. The 10th annual Woman’s Victory Open raised more than $63,000 to benefit the The 2008 event netted over $50,000 for golf tournament, presented by Capital One breast and gynecologic cancer programs the Community Care Fund, which was and Saia Electric, netted $135,000. Since of Woman’s. Tour of Ponds organizer established to provide vital healthcare its inception, funds raised have exceeded and Harb’s Oasis owner, Charbel Harb, services and programs for local women $700,000, helping to support the mobile presented a check in the amount of $9,600 and infants, including programs such outreach program provided by Woman’s representing the proceeds from the event. as the neuro-developmental clinic for Mobile Mammography Coach, which helps infants, care for sexual assault victims educate women in the community about and prenatal education. early detection and offers screenings for women who need it most.

Woman’s 2009 Cancer Annual Report 17 Fact Breast cancer is diagnosed more often in Caucasian women than Latina, Asian or African-American women.

Woman’s Health Research Department Founded in 1994, Woman’s Health Research Department provides clinical and molecular biology/genetic research services for the hospital. The goal of research at Woman’s is to promote women and infants’ health research, while enhancing medical care and improving patient outcomes. The research staff provides technical and administrative support to Woman’s staff who conduct research. 2008 The Department has two divisions: I. Clinical Division: II. Molecular Biology/ Genetics/ A. Molecular Investigation of Breast The clinical division conducts research Oncology Division and Ovarian Tumor Tissue (a study in related to polycystic ovarian disease, The molecular biology/genetics/oncology collaboration with Dr. Mary-Claire King, metabolic syndrome and insulin resistance. division conducts translational cancer University of Washington in Seattle); Cancer This division coordinates hospital research studies including looking at B. Molecular Analysis of Human Breast studies, such as those involving fertility inherited cancer and tumor markers. Cancer (a study in collaboration with Dr. and reproductive hormones, maternal- This division coordinates hospital studies Mary-Claire King); fetal medicine, neonatal medicine, involving gynecologic oncology, surgical investigational medications, physical treatment of breast cancer, genetics and C. Prognostic Study of Sentinel Node and therapy, exercise and administrative and molecular biology. Bone Marrow Metastasis in Women Committee social issues. with Clinical T1 or T2 and N0M0 Breast The molecular biology laboratory utilizes Cancer; and, advanced technology for mutation detection, allowing the research team D. Quantitative Immunoperoxidase to perform clinically relevant genetic Analysis of LH and GnRH Receptor research. The pathology laboratory works Status in Cancer of the Breast, closely with the research team to perform Endometrium and Ovary. many of these studies.

In 2008, the Woman’s Health Research Department had 49 active research studies, 39 of which were cancer-related studies. The following four studies are related to breast cancer diagnosis or treatment:

18 Woman’s 2009 Cancer Annual Report Physician Members Chair, Pathologist Beverly Ogden, MD Vice-Chair and Cancer Liaison Physician, Surgeon ...... David Boudreaux, MD 2008Medical Oncologist Bryan Bienvenu, MD Medical Oncologist Deborah Abernathy, MD Radiologist ...... James Ruiz, MD Radiation Oncologist Maurice King, Jr., MD Radiation Oncologist Will Russell, MD Ob/Gyn ...... Jane Peek, MD CancerOb/Gyn ...... Julius Mullins, MD Gyn Oncologist ...... Giles Fort, MD Gyn Oncologist (MEC Liaison) ...... Sterling Sightler, MD Surgeon ...... Michael Hailey, MD

CommitteeAdministrative Liaisons Senior Vice President/CNE, Nursing Services Tricia Johnson, RN, MN, CNAA Senior Vice President, Medical Staff Services Nancy Crawford, RHIA Senior Vice President, Operations Jamie Haeuser, MHA Director, Health Information Management ...... Danielle Berthelot, RHIA Manager, Health Information Management Tonya Songy, RHIA, CPC Cancer Registrar Heather McCaslin, RHIT, CTR Cancer Registrar Gina Sommers, MA Director, Quality/UM Del Currier, RN, BSN, CPHQ Oncology Social Worker ...... Robin Maggio, LCSW Director, Gyn/Onc ...... Mary Ann Smith, RN, OCN Manager, Breast Center Mary Salario, RN, BSN Data Manager/Oncology Sherry Noel, RN, BSN Clinical Dietitian ...... Paula Meeks, MS, LDN, RD Director, Pharmacy Peggy Dean, RPH Director, Corporate Communications Janice Lamy

The Cancer Committee shall: • develop and evaluate the annual goals and objectives for the clinical, educational, and programmatic activities related to cancer; • promote a coordinated, multidisciplinary approach to patient management; • ensure that educational and consultative cancer conferences cover all major sites and related issues; • ensure that an active supportive care system is in place for patients, families, and staff; • monitor quality management and improvement through completion of quality management studies that focus on quality, access to care, and outcomes; promote clinical research; • supervise the cancer registry and ensure accurate and timely abstracting, staging, and follow-up reporting; • encourage data usage and regular reporting; • ensure content of the annual report meets requirements; • perform quality control of registry data; and • publish the annual report by the end of the fourth quarter of the following year.

1996 A multidisciplinary team discovers a second inherited breast cancer gene on chromosome 13 (BRCA2). 19 Fact Women who are physically inactive throughout life may have an increased risk of breast cancer.

The Cancer Registry Program of Woman’s Approved cancer programs are To stay abreast of the most recent changes is a medical data collection system of encouraged to improve their quality of in the field of cancer registry, the staff patients diagnosed with cancer and/or patient care through various cancer- attends educational conferences at the Cancerreceiving cancer treatment at the hospital. related programs. These programs focus local and national levels. In 2008, staff Cancer cases are abstracted and reported on a full range of medical services involved members attended LCRA state meetings in to the Louisiana State Tumor Registry in the diagnosis and treatment of cancer New Orleans and Baton Rouge. The Cancer in accordance with state and federal including: prevention, early diagnosis, Registry Manager also attended the NCRA guidelines. The information gathered by pretreatment evaluation, staging, optimal convention held in Minneapolis, MN, in the registry is used for presentation in the treatment, psychosocial support and care April 2008. Cancer Annual Report as well as in other at the end of life. RegistryThe cancer program coordinator at specialty reports. The reference date for the Cancer Registry Woman’s is a Certified Tumor Registrar Within the Cancer Registry, coordination is January 1, 1991. The total number of (CTR) and a Registered Health Information of the hospital’s compliance with cases in the database is 7,151 with 6,623 Technician (RHIT). She is a member of the standards of the American College of cases being analytical and 528 cases American Health Information Management Surgeons’ Commission on Cancer (CoC) being non-analytical. The Cancer Registry Association (AHIMA). The cancer program 2008takes place to maintain accreditation. To at Woman’s accessioned 587 new cases abstractor is also a CTR. A Registered meet and maintain approval through the during 2008. Of the newly accessioned Health Information Administrator (RHIA), CoC, a facility must undergo a rigorous cases, all were analytical. These numbers who is also a Certified Professional Coder evaluation and review of its performance include in-situ cancers of the breast, cervix, (CPC), manages the department. She in many areas of the facility’s cancer vagina and vulva. is also a member of the AHIMA and of program. This review is performed onsite the American Academy of Professional ActivitiesThe cancer program coordinator and every three years. On May 19, 2008, Coders (AAPC). All three are members of cancer program abstractors identify all Woman’s was surveyed by the CoC and the National Cancer Registrars Association cancer cases according to established currently maintains full accreditation with (NCRA) and the Louisiana Cancer Registrars state and federal guidelines. These commendation. Association (LCRA), and the Region II individuals work directly with the medical Cancer Registrar Forum. staff, nursing and other allied health professionals within the Baton Rouge area as well as personnel of the Baton Rouge Regional Tumor Registry, Louisiana State Tumor Registry and tumor registrars across the country to gain access to information in abstracting and completing all pertinent cancer cases.

2000 The Human Genome Project is completed after identifying approximately 30,000 human genes and discovering that 95% of the human genome is made of “junk” DNA. Interestingly, the project costs approximately $3 billion—roughly 20 equivalent to the 3 billion base pairs in the human genome. A ge at Diagnosis Number of Cases Percent Cancer of the Breast 373 Analytic Cases 20-29 2 <1 2008 Cancer 30-39 17 5 40-49 Cancer76 20 50-59 88 24 60-69 98 26 70-79 67 18 80-89 23 6 Registry 90-99 2 <1 of the Race Number of Cases Percent Caucasian 276 74 African American 95 25 Asian/Other 2 <1 2008 Stage at Diagnosis Number of CBreastases Percent Stage 0 76 20 Stage I 153 41 Stage II 103 28 Activities Stage III 39 10 Stage IV 1 <1 Unknown/Not Applicable 1 <1

Treatment First Course Number of Cases Percent Surgery 116 31 Surgery/Chemotherapy 37 10 Surgery/Radiation 45 12 Surgery/Radiation/Chemotherapy 38 10 Surgery/Hormone 32 9 Surgery/Radiation/Hormone 79 21 Surgery/Chemotherapy/Hormone 8 2 Surgery/Radiation/Chemotherapy/Hormone 18 5

Histology Number of Cases Percent Infiltrating Ductal Carcinoma 251 67 Ductal Carcinoma In-Situ 27 7 Lobular Carcinoma In-Situ 2 <1 Lobular Carcinoma 28 8 Ductal & Lobular Carcinoma In-Situ 48 13 Infiltrating Ductal & Lobular Carcinoma 8 2 Mucinous Adenocarcinoma 5 1 Metaplastic Carcinoma NOS 1 <1 Infiltrating Ductal Carcinoma with Paget’s Disease 1 <1 Phyllodes Tumor 2 <1

Woman’s 2009 Cancer Annual Report 21 Cancer of the Uterus A ge at Diagnosis Number of Cases Percent 79 Analytic Cases 20-29 0 0 2008 Cancer30-39 2 <3 40-49 3 <4 50-59 32 41 60-69 19 24 70-79 17 22 80-89 6 8 of the90-99 0 0

Race Number of Cases Percent Caucasian 61 77 African American 18 23 Asian/Other 0 0 Uterus Stage at Diagnosis Number of Cases Percent Stage 0 0 0 Stage I 55 70 Stage II 2 3 Stage III 12 15 Stage IV 5 6 Unknown/Not Applicable 5 6

Treatment First Course Number of Cases Percent Surgery 54 68 Surgery/Radiation 10 13 Surgery/Chemotherapy 12 15 Surgery/Radiation/Chemotherapy 3 4

Histology Number of Cases Percent Endometrioid Adenocarcinoma 44 56 Mixed Cell Adenocarcinoma 1 <2 Adenocarcinoma, NOS 15 15 Endometrial Stromal Sarcoma 1 <2 Carcinosarcoma 6 3 Serous Adenocarcinoma 5 <2 Adenosquamous Carcinoma 1 <2 Small Cell Carcinoma 1 <2 Clear Cell Adenocarcinoma 2 3 Mucinous Adenocarcinoma 1 <2 Mixed Type Rhabdomyosarcoma 1 <2 Adenosarcoma 1 <2

22 Woman’s 2009 Cancer Annual Report A ge at Diagnosis Number of Cases Percent Cancer of the Ovary 45 Analytic Cases 30-39 3 7 2008 40-49 Cancer4 9 50-59 10 22 60-69 15 33 70-79 9 20 80-89 4 9

Race Number of Cases ofPercent the Caucasian 39 87 African American 6 13 Asian/Other 0 0

Stage at Diagnosis Number of Cases Percent Stage I 12 Ovary27 Stage II 5 11 Stage III 21 47 Stage IV 2 4 Unknown /Not Applicable 5 11

Treatment First Course Number of Cases Percent Surgery/Chemotherapy 33 73 Surgery 10 22 Surgery/Chemotherapy/Hormone Therapy 1 <3 None 1 <3

Histology Number of Cases Percent Serous Cystadenocarcinoma, NOS 26 58 Endometrioid Adenocarcinoma 2 4 Adenocarcinoma 5 11 Granulosa Cell Tumor 5 11 Mucinous Cystadenocarcinoma 2 4 Carcinoid Tumor, NOS 1 <3 Signet Ring Cell Carcinoma 1 <3 Carcinoma, NOS 1 <3 Epithelioid Leiomyosarcoma 1 <3 Mullerian Mixed Tumor 1 <3

Woman’s 2009 Cancer Annual Report 23 Cancer of the Cervix A ge at Diagnosis Number of Cases Percent 44 Analytic Cases 20-29 4 9 2008 Cancer30-39 9 <21 40-49 9 <21 50-59 10 23 60-69 7 16 70-79 5 11 80-89 0 0 of the Race Number of Cases Percent Caucasian 35 80 African American 9 <21 Asian/Other 0 0 CervixStage at Diagnosis Number of Cases Percent Stage 0 10 23 Stage I 22 50 Stage II 3 7 Stage III 5 11 Stage IV 1 2 Unknown/Not Applicable 3 7

Treatment First Course Number of Cases Percent Surgery 31 71 Radiation 1 2 Surgery/Radiation/Chemotherapy 4 9 Radiation/Chemotherapy 2 5 Surgery/Radiation 5 11 Surgery/Chemotherapy 0 0 None 1 2

Histology Number of Cases Percent Squamous Cell Carcinoma 22 50 Adenocarcinoma, NOS 9 21 Squamous Cell Carcinoma, Microinvasive 1 2 Clear Cell Adenocarcinoma 1 2 Squamous Cell Carcinoma In-Situ 8 18 Adenocarcinoma In-Situ 2 5 Leiomyosarcoma, NOS 1 2

24 Woman’s 2009 Cancer Annual Report Site Number of Cases Percent Cancer of the Vulva 19 76 Vulva and Vagina 25 Analytic Cases Vagina Cancer6 24 2008 Age at Diagnosis Number of Cases Percent 30-39 1 4 40-49 3 12 50-59 7 of28 the 60-69 5 20 70-79 5 20 80-89 4 16

Race Number of Cases Percent Caucasian 23 92 African American Vulva2 8 & Asian/Other 0 0

Stage at Diagnosis Number of Cases Percent Stage 0 8 32 Stage I 9 36 Stage II Vagina7 28 Stage III 1 4 Stage IV 0 0 Unknown/Not Applicable 0 0

Treatment First Course Number of Cases Percent None 1 4 Surgery 21 84 Surgery/Chemotherapy 0 0 Surgery/Radiation/Chemotherapy 1 4 Radiation/Chemotherapy 1 4 Radiation 0 0 Chemotherapy 1 4

Histology Number of Cases Percent Squamous Cell Carcinoma 13 52 Squamous Cell Carcinoma In-Situ 8 32 Squamous Cell Carcinoma, Microinvasive 2 8 Adenocarcinoma 1 4 Malignant Melanoma 1 4

Woman’s 2009 Cancer Annual Report 25 2008 Tumor Report Site Distribution TumorAnalytic Cases Only Tumor Group Analytic Stage Stage Stage Stage Stage Not 0 I II III IV applicable All sites 587 96 255 122 81 11 18 Breast 373 76 153 103 39 1 1 Conferences Corpus Uteri/Uterus NOS 79 0 55 2 12 5 5 ReportOvary 45 0 12 5 21 2 3 Cervix Uteri 44 10 22 3 5 1 1 Vulva 19 7 8 3 1 0 0 Peritoneum, Omentum, Mesentery 7 0 0 0 0 0 7 Vagina 6 1 1 4 0 0 0 Other Female Genital 4 0 1 0 3 0 0 Colon 3 0 0 1 0 1 1 Melanoma of Skin 2 2 0 0 0 0 0 Kidney and Renal Pelvis 2 0 1 1 0 0 0 Small Intestine 1 0 0 0 0 1 0 Thyroid 1 0 1 0 0 0 0 Non-Hodgkin’s Lymphoma 1 0 1 0 0 0 0

2008 All Sites Distribution by Age A ge at Diagnosis Number of Cases Percent 20-29 6 <1 30-39 34 6 40-49 96 16 50-59 151 26 60-69 151 26 70-79 109 19 80-89 38 6 90-99 2 <1

2008 All Sites Distribution by Race Race Number of Cases Percent Caucasian 453 77 African American 132 22 Asian/Other 2 1

26 Woman’s 2009 Cancer Annual Report Cancer Registry Report on Cases Presented at Breast Cancer Conference by Age January 2008- December 2008 Tumor Total Conferences held ...... 9 Total Cases Presented ...... 26 Average number of attendees ...... 24 ConferencesTotal number of analytic breast cancer cases accessioned in 2008 373

A ge at Diagnosis Number of Cases Percent 20-29 1 4 30-39 3 11 40-49 6 23 50-59 6 23 60-69 8 31 70-79 1 4 80-89 1 4 Total 26 100 Histology of Cases Presented: Cribriform Carcinoma In-Situ Inflammatory Carcinoma Infiltrating Ductal Carcinoma Lobular Carcinoma Ductal Carcinoma In-Situ Comedo Carcinoma In-Situ Mucinous Adenocarcinoma

Woman’s 2009 Cancer Annual Report 27 Cancer Registry Report on Cases Presented at Gynecologic Cancer Conference by Age January 2008-December 2008

Total conferences held ...... 9 Total cases presented ...... 48 Average number of attendees ...... 6 Total number of analytic gynecologic cases accessioned in 2008 ...... 204

A ge at Diagnosis Number of Cases Percent 30-39 2 4 40-49 2 4 50-59 13 27 60-69 12 25 70-79 9 19 80-89 9 19 90-99 1 2 Total 48 100

Sites Presented: Histology of Cases Presented: Endometrium Carcinosarcoma Cervix Squamous Cell Carcinoma Ileum Sarcoma Ovary Adenocarcinoma Vulva Papillary Serous Adenocarcinoma Kidney Endometrioid Adenocarcinoma Vagina Clear Cell Adenocarcinoma Peritoneum Mixed Mullerian Malignant Tumor Pituitary Gland Melanoma Spindle Cell Type Granulosa Carcinoma Renal Cell Carcinoma Leiomyosarcoma Papillary Mesothelial Proliferation

28 Woman’s 2009 Cancer Annual Report About Woman’s Woman’s Hospital opened in 1968 to meet the unique needs of women requiring specialized care. We have more experience with gynecologic and other surgery for women than most other hospitals in Louisiana. Today, we offer the latest diagnostic technology and surgical techniques. Woman’s Hospital also has more doctors and nurses with exceptional experience in caring for women before, during, and after surgery. We are here to provide the resources women need through all the changes and stages of their lives.

Woman’s Hospital is a 501(c)(3) nonprofit organization governed by a board of community volunteers. Contributions, along with proceeds from hospital operations, are reinvested in research, community education, service programs, equipment, and facilities.

Woman’s Hospital is a Magnet hospital signifying Sites Presented: Histology of Cases Presented: nursing excellence and quality patient care. Endometrium Carcinosarcoma Cervix Squamous Cell Carcinoma Ileum Sarcoma Ovary Adenocarcinoma Vulva Papillary Serous Adenocarcinoma Kidney Endometrioid Adenocarcinoma Vagina Clear Cell Adenocarcinoma Peritoneum Mixed Mullerian Malignant Tumor Pituitary Gland Melanoma Spindle Cell Type Granulosa Carcinoma Renal Cell Carcinoma Leiomyosarcoma Papillary Mesothelial Proliferation

Woman’s Hospital is accredited by The Joint Commission. The oncology program is also accredited by the American College of Surgeons.